96367

Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less

Code 96367. Medicare covered 930,254 of these. Here is what providers billed and what Medicare allowed, state by state.

$120.33Billed, national avg
$27.64Medicare allowed
4.4xBilled vs allowed
7.2xHighest vs lowest state

Providers in Alaska billed the most for this, at $232.28. In Guam the average was $32.37. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$232.28$30.387.6x2,886
Connecticut$206.24$30.756.7x3,174
Wisconsin$202.08$26.057.8x2,250
South Dakota$191.32$27.556.9x652
Minnesota$176.60$28.296.2x7,827
Delaware$174.74$28.766.1x2,231
California$165.48$31.975.2x94,465
Wyoming$165.07$27.825.9x2,002
New Hampshire$163.24$28.625.7x1,090
Virgin Islands$157.16$28.745.5x693
Missouri$155.86$25.976.0x9,825
Rhode Island$153.01$27.795.5x157
South Carolina$151.64$26.325.8x16,429
New Jersey$149.25$31.234.8x43,127
Illinois$144.93$26.925.4x43,251
Vermont$140.93$29.674.7x2,377
Oregon$131.79$28.584.6x5,447
Maine$131.43$27.554.8x842
Alabama$129.36$24.825.2x22,044
Texas$127.91$26.784.8x125,766
Georgia$127.15$25.694.9x26,746
Kansas$125.94$24.825.1x21,469
Kentucky$125.36$24.465.1x2,479
Colorado$123.76$28.094.4x15,369
Louisiana$120.53$25.164.8x5,889
New Mexico$118.96$25.544.7x6,547
Massachusetts$118.69$29.694.0x2,264
Maryland$118.40$30.823.8x33,984
Nevada$113.70$27.234.2x7,483
Mississippi$112.57$25.134.5x9,748
Armed Forces Pacific$110.00$32.733.4x16
Tennessee$109.81$25.124.4x38,374
North Carolina$109.25$26.304.2x12,850
Virginia$108.83$27.813.9x28,050
Pennsylvania$107.40$28.063.8x23,813
Indiana$106.59$25.734.1x9,243
Ohio$104.67$25.984.0x18,053
New York$104.15$29.653.5x46,073
Washington$99.39$28.903.4x7,612
Arkansas$97.66$24.574.0x19,303
North Dakota$96.94$26.753.6x872
District of Columbia$95.27$31.553.0x306
Hawaii$90.95$30.932.9x826
Florida$88.10$27.033.3x115,509
Iowa$85.97$25.573.4x15,927
Arizona$85.49$26.903.2x29,569
Michigan$84.05$26.573.2x14,609
Idaho$79.34$25.533.1x1,934
Nebraska$79.28$25.693.1x9,761
Montana$78.80$27.752.8x71
West Virginia$73.56$26.642.8x348
Utah$70.06$25.702.7x6,866
Oklahoma$66.91$25.292.6x6,956
Unknown$61.68$26.612.3x410
Puerto Rico$33.96$27.031.3x4,241
Guam$32.37$30.091.1x148

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

← All procedures